Leukemia in Children

What is leukemia?

Leukemia is cancer of the white blood cells. This cancer starts in the bone marrow, the sponge-like tissue in the center of most bones. Healthy bone marrow makes several types of blood cells, including white blood cells. Normal white blood cells help protect the body from disease. They are part of the immune system.

In children with leukemia, the bone marrow creates too many white blood cells. The white blood cells (leukemia) are abnormal and do not protect the body or fight disease.

Leukemia cancer cells may grow slowly or quickly. When they grow slowly, it is called chronic leukemia. When they grow quickly, it is called acute leukemia. Most childhood leukemia is of the acute type. Children rarely get chronic types of leukemia.

Leukemias we treat

St. Jude Children’s Research Hospital treats children with many different types of leukemias, including difficult-to-treat cases. These include:

St. Jude also treats patients with myelodysplasia, a pre-leukemic disorder. As many as 30% of patients with myelodysplasia may later have AML.

Is leukemia hereditary?

While having a family history of leukemia may raise the risk of getting leukemia, doctors do not know exactly by how much. St. Jude researchers have discovered that genes have been found to play a role in developing leukemia, but just because a parent, sibling or other relative had leukemia does not mean your child will also get it. In a small number of families, multiple relatives may be diagnosed with leukemia. But nearly everyone who gets leukemia lacks a family history of the disease.

How does leukemia affect the body?

Leukemias often “grow” quickly. The leukemia cells grow by dividing in half to make more leukemia cells. Over time, many leukemia cells may form in the bone marrow and bloodstream. Once leukemia cells are in the blood stream, they can travel all over the body. They often go to the lymph nodes, spleen, liver, brain, spinal cord and testicles. Leukemia cells can keep healthy cells from working normally. These cells take available nutrients and energy and starve the normal cells.

How common is leukemia?

Although childhood leukemia is considered a rare disease, it is the most common cancer that affects children. Almost 30% of children or teens with cancer have some form of leukemia.

Among the different types of childhood leukemia, ALL is the most common. Around 75% of children who are diagnosed with leukemia have ALL.

What are the symptoms of leukemia?

Not all children or teens with leukemia have symptoms. Those who do may have a few or many symptoms. Common symptoms of childhood leukemia include:

  • Fever
  • Night sweats
  • Feeling tired
  • Feeling cold
  • Headaches
  • Feeling dizzy or lightheaded
  • Pale skin
  • Feeling out of breath
  • Loss of appetite
  • Swollen belly
  • Bruising or bleeding easily
  • Frequent nosebleeds
  • Bleeding gums
  • Flat, dark-red skin spots (petechiae) due to bleeding under the skin
  • Getting sick frequently
  • Lumps in the neck, underarm, stomach or groin (sometimes called “swollen glands”)
  • Bone or joint pain

Symptoms can also be caused by many conditions other than leukemia. Talk to your doctor if your child has any of these symptoms.

How is leukemia diagnosed?

If your child has symptoms of leukemia, the doctor will do a full physical exam. Several tests are used for diagnosis. These include:

  • Complete blood count (CBC)—A small sample of blood is taken from the child’s vein. The different types of blood cells in the sample are then counted in the lab. Children with leukemia will usually have too many white blood cells or too few red blood cells.
  • Blood smear—A small sample of blood taken from a finger is spread on a glass slide. In the lab, scientists look at the blood with a microscope. People with leukemia often have abnormal numbers of blood cells and changes in the way these cells look.
  • Bone marrow aspiration and biopsy—The child is usually given anesthesia, a medicine that causes sleep, for this test. A thin, hollow needle is put into a bone, often in the hip. A small amount of bone marrow is aspirated (taken out). For the biopsy, a slightly larger needle is used to take out a small piece of bone. Experts look at the bone and the bone marrow in the lab to see if leukemia cells are present.

How is leukemia treated?

Usually, there are three stages to leukemia treatment:

  1. Induction—to kill leukemia cells in the blood and bone marrow and put the disease into remission (a return to normal blood cell counts)
  2. Consolidation/intensification—to rid the body of any remaining cells that could begin to grow and cause the leukemia to return (relapse)
  3. Maintenance—to destroy any cancer cells that might have survived the first two phases

Four types of treatment may be used during any of these treatment phases:

  • Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells.
    • Chemo may be injected into the bloodstream, so that it can travel through the body.
    • Some chemo may be given by mouth.
    • Combination therapy uses more than one type of chemo at a time.
  • Stem cell transplant—replaces blood-forming cells in the bone marrow that have been killed by chemo and/or radiation therapy.
    • A stem cell transplant gives the patient new blood cells from a donor’s blood or bone marrow. These cells grow into healthy blood cells to replace the ones the patient lost.
    • Some types of stem cell transplants may be called “bone marrow transplants” because the cells come from the donor’s bone marrow.
  • Radiation therapy—uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing.
  • Targeted therapy—uses medicines or other treatments that target and attack specific cancer cells without harming healthy cells.

What are the survival rates for leukemia?

The survival rate five years after diagnosis varies for different leukemia types. The five-year survival rate for patients with AML is around 70%, for patients with APL it is around 90% and for mixed phenotype acute leukemia it is around 60%.

For ALL, the most common childhood cancer, the five-year survival rate after diagnosis is more than 85%. St. Jude patients with ALL have a survival rate of 94%, the best worldwide outcome for this disease.

Why choose St. Jude for your child’s leukemia treatment?

  • St. Jude is the only National Cancer Institute–designated Comprehensive Cancer Center devoted solely to children.
  • St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
  • The nurse-to-patient ratio at St. Jude is unmatched—averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
  • The hospital’s leukemia studies have pioneered the way the world treats childhood leukemia.
  • St. Jude pioneered outpatient clinical trials for children with leukemia, reducing the need for inpatient stays.
  • The St. Jude Children’s Research Hospital-Washington University Pediatric Cancer Genome Project is uncovering the genetic basis for some of the most difficult-to-cure childhood cancers.

Associated Clinical Trials

ALLR18: Therapy for Pediatric Relapsed or Refractory Precursor B-Cell Acute Lymphoblastic Leukemia and Lymphoma

A Phase II Study of Therapy for Pediatric Relapsed or Refractory Precursor B-Cell Acute Lymphoblastic Leukemia and Lymphoma

Diseases Treated:

Relapsed or refractory precursor B-cell acute lymphoblastic leukemia and lymphoma

Eligibility:

  • B-cell acute lymphoblastic leukemia or lymphoblastic lymphoma that has:
    • Come back after treatment the first time
    • Did not respond to treatment the first time
  • Less than 22 years of age
  • Does not have HIV or hepatitis B infection
View Trial

ALTE1631: Web-based Exercise Study for Children and Adolescents with Acute Lymphoblastic Leukemia

Web-based Physical Activity Intervention among Children and Adolescents with Acute Lymphoblastic Leukemia

Diseases Treated:

Acute lymphoblastic leukemia

Eligibility:

This is a non-therapeutic clinical trial open to patients receiving treatment at a Children’s Oncology Group (COG)-affiliated institution.

  • At least 8 years old and younger than 16 years old
  • Newly diagnosed acute lymphoblastic leukemia (ALL), in first remission
  • Completed chemotherapy within past 6 months
  • Performance status corresponding to ECOG scores of 0, 1, 2
  • Fewer than 420 minutes of moderate to vigorous physical activity (MVPA) over the last week
  • Access to smart phone (Android 4.3 or later, iOS 7.1 or later or computer with connection to the internet)
  • Able to write and read English (patient and at least one parent/guardian)
  • Not pregnant
View Trial

APNEA: Sleep Apnea in Hodgkin Lymphoma Survivors Treated with Radiation to the Chest

Obstructive Sleep Apnea in Survivors of Hodgkin Lymphoma Treated with Thoracic Radiation

Diseases Treated:

Hodgkin lymphoma

Eligibility:

This is a non-therapeutic clinical trial that is only open to former St. Jude patients, their family members and friends.

Hodgkin lymphoma survivor

  • Current St. Jude LIFE participant, treated with thoracic radiation for Hodgkin lymphoma
  • At least 18 years old
  • At least 5 years from original diagnosis

Comparison group

  • Sibling, parent, relative or friend of a current or former St. Jude patient
  • At least 18 years old
View Trial

cHOD17: Risk-Adapted Therapy for Children and Young Adults with Hodgkin Lymphoma

Pediatric Classical Hodgkin Lymphoma Consortium Study

Diseases Treated:

Lymphoma

Eligibility:

  • Previously untreated CD30+ classical Hodgkin lymphoma
  • 21 years or younger at time of diagnosis (low-risk and intermediate-risk patients)
  • 18 years or younger (high-risk patients)
View Trial

DSCOG: Learning, Behavior and Social Skills in Survivors of Childhood Leukemia with Down syndrome

Neurocognitive and Psychosocial Outcomes in Survivors of Childhood Leukemia with Down syndrome

Diseases Treated:

Leukemia

Eligibility:

This is a non-therapeutic clinical trial that is open only to patients who were treated at St. Jude Children’s Research Hospital since 1980 and are currently followed at the hospital.

  • St. Jude Children’s Research Hospital patient with acute leukemia (i.e., ALL or AML)
  • Trisomy 21 Down syndrome diagnosis
  • Completed all cancer therapy at St. Jude since 1980 and at least six months prior to study visit
  • English as the primary language
View Trial

G4K: Genomes for Kids

Next Generation Sequencing of Normal Tissue Prospectively in Pediatric Oncology Patients

Diseases Treated:

Non-therapeutic

Eligibility:

This is a non-therapeutic clinical trial that is open to St. Jude patients.

  • Solid tumor or liquid tumor (cancerous or non-cancerous)
View Trial

HAPNK1: Blood and Marrow Transplant (BMT) for Children with Leukemia/Lymphoma

Haploidentical Donor Hematopoietic Progenitor Cell and Natural Killer Cell Transplantation with a TLI-Based Conditioning Regimen in Patients with Hematologic Malignancies

Diseases Treated:

Leukemia and lymphoma

Eligibility:

  • 21 years and younger
  • Does not have a suitable HLA-matched sibling donor or volunteer HLA-matched unrelated donor or is not a candidate for conventional matched donor transplant due to refractory disease
  • Has a suitable single haplotype-matched family member donor
  • High-risk hematologic malignancy, including certain diagnoses of:
    • Acute lymphoblastic leukemia (ALL)
    • Acute myeloid leukemia (AML)
    • Chronic myelogenous leukemia (CML)
    • Myelodysplastic syndrome (MDS)
    • Hodgkin lymphoma
    • Non-Hodgkin lymphoma
View Trial

HOD08: Combination Chemotherapy with or without Radiation Therapy in Treating Young Patients with Favorable-Risk Hodgkin Lymphoma

Reduced Duration Stanford V Chemotherapy With or Without Low-Dose Tailored-Field Radiation Therapy for Favorable Risk Pediatric Hodgkin Lymphoma

Diseases Treated:

Hodgkin lymphoma

Eligibility:

  • Diagnosis of early-stage Hodgkin lymphoma 
  • Hodgkin lymphoma that has not been previously treated
  • 21 years of age or younger
View Trial

HODLP: First International Inter-Group Study for Nodular Lymphocyte Predominant Hodgkin Lymphoma in Children and Adolescents

Surgery Alone, Surgery With Cyclophosphamide, Vinblastine, and Prednisolone (CVP), or CVP Alone in Treating Young Patients With Stage IA or Stage IIA Nodular Lymphocyte-Predominant Hodgkin Lymphoma

Diseases Treated:

Lymphocyte predominant Hodgkin lymphoma 

Eligibility:

  • Diagnosis of early-stage lymphocyte-predominant Hodgkin lymphoma (LPHL)
  • LPHL that has not been previously treated with chemotherapy or radiation therapy
  • 18 years of age or younger

 

View Trial

LDTAM: Low-Dose Tamoxifen Citrate in Reducing Breast Cancer Risk in Radiation-Induced Cancer Survivors

Low-dose Tamoxifen in Hodgkin Lymphoma Survivors for Breast Cancer Risk Reduction: A Phase IIB Randomized Placebo-Controlled Trial

Diseases Treated:

For survivors of Hodgkin lymphoma

Eligibility:

  • Females, 25 years of age or older.
  • Participant does not plan to become pregnant in the next 2 years and is not currently breast feeding.
View Trial

LiSTENING: Learning in Story: Elicited Narrative Informs Navigating Genetics

Eligibility:

This is a non-therapeutic clinical trial open to St. Jude patients only.

Participants have been pre-identified by the primary care team as an English-speaking, four-member family unit diagnosed with TP53 mutation.

View Trial

M16-106: Combination Chemotherapy for Relapsed Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma

Phase I Study of Venetoclax with Navitoclax and Chemotherapy for Relapsed Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma

Diseases Treated:

Acute lymphoblastic leukemia, lymphoblastic lymphoma

Eligibility:

  • Acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LL) that has not responded to treatment or has come back after treatment
  • Between 4 and 45 years old
  • Weigh at least 20 kg (44 lbs)
  • Able to swallow pills

 

 

View Trial

NCBP01: Safety Study of Unlicensed, Investigational Cord Blood Units Manufactured by the NCBP for Unrelated Transplantation

A Multicenter Safety Study of Unlicensed, Investigational Cryopreserved Cord Blood Units (CBUs) manufactured by the National Cord Blood Program (NCBP) and provided for Unrelated Hematopoietic Stem Cell Transplantation of Pediatric and Adult Patients

Diseases Treated:

Leukemia and other blood diseases

Eligibility:

This is a non-therapeutic clinical trial that is only open to St. Jude patients.

  • Participant is receiving an allogeneic hematopoietic stem cell (HSC) transplant at St. Jude Children's Research Hospital using an unlicensed cord blood unit (CBU).
  • Participant may be of any age and either gender.
  • Participant has a medical disorder affecting the hematopoietic system that is inherited, acquired, or a result from myeloablative treatment.
  • Participant is receiving HPC-CORD BLOOD product manufactured by NCBP (at least one, if the graft contains more than one units).
View Trial

REF2HCT: Haploidentical Bone Marrow Transplant for Leukemia and Lymphoma

Provision of TCRγδ T Cells and Memory T Cells plus Selected Use of Blinatumomab in Naïve T-cell Depleted Haploidentical Donor Hematopoietic Cell Transplantation for Hematologic Malignancies Relapsed or Refractory despite Prior Transplantation

Diseases Treated:

Eligibility:

  • 21 years old and younger
  • Diagnosed with one of the following that has come back or did not improve after bone marrow transplant
    • Acute lymphoblastic leukemia (ALL)
    • Acute myeloid leukemia
    • Myeloid sarcoma
    • Chronic myeloid leukemia (CML)
    • Juvenile myelomonocytic leukemia (JMML)
    • Myelodysplastic syndrome (MDS)
    • Non-Hodgkin lymphoma (NHL)
  • Has a family member who is a suitable stem cell donor
View Trial

RELPALL: Phase I Study of Palbociclib with Chemotherapy in Children with Acute Lymphoblastic Leukemia

Phase I Study of Palbociclib in Combination with Chemotherapy in Pediatric Patients with Relapsed or Refractory Acute Lymphoblastic Leukemia

Diseases Treated:

Acute lymphoblastic leukemia

Eligibility:

  • Younger than 22 years old
  • Diagnosis of relapsed or refractory acute lymphoblastic leukemia (ALL)
View Trial

SELHEM: Selinexor With Fludarabine and Cytarabine for Treatment of Refractory or Relapsed Leukemia or Myelodysplastic Syndrome

Phase I/II Study of the Selective Inhibitor of Nuclear Export Selinexor (KPT-330) in Combination with Fludarabine and Cytarabine in Patients with Refractory or Relapsed Leukemia or Myelodysplastic Syndrome

Diseases Treated:

Relapsed or refractory leukemia or hematologic malignancies

Eligibility:

(Phase II)

  • 21 years of age or younger
  • Acute myeloid leukemia (AML)
  • No history of HIV infection
View Trial

SJBC3: Mature B-cell Lymphoma and Leukemia Study III

Risk-Adapted Therapy in Treating Young Patients with Mature B-Cell Lymphoma or Leukemia

Diseases Treated:

Leukemia and lymphoma

Eligibility:

  • 21 years of age or younger
  • Newly diagnosed mature B-cell non-Hodgkin lymphoma and leukemia
  • No previous treatment (no more than 72 hours of steroids, one intrathecal chemotherapy treatment, and/or emergency radiation)
View Trial

SJCAR19: CAR T-Cell Therapy for Children and Young Adults with Acute Lymphoblastic Leukemia

A Phase I/II Study Evaluating CD19-Specific CAR Engineered Autologous T-Cells in Pediatric and Young Adult Patients with Relapsed or Refractory CD19+ Acute Lymphoblastic Leukemia

Diseases Treated:

Acute lymphoblastic leukemia

Eligibility:

 

 

View Trial

TINI: Total Therapy for Infants With Acute Lymphoblastic Leukemia (ALL)

Diseases Treated:

Acute lymphoblastic leukemia (ALL)

Eligibility:

  • Newly diagnosed ALL
  • 1 year of age or younger at the time of diagnosis
  • Has not had any — or has had limited — prior therapy
  • Does not have mature B-cell ALL, acute myeloid leukemia (AML) or Down syndrome
View Trial

TOT17: Total Therapy for Children with Acute Lymphoblastic Leukemia and Lymphoma

Total Therapy Study 17 for Newly Diagnosed Patients with Acute Lymphoblastic Leukemia and Lymphoma

Diseases Treated:

Leukemia and lymphoma

Eligibility:

  • Diagnosis of B-cell or T-cell acute lymphoblastic leukemia (ALL) or acute lymphoblastic lymphoma (LLy)
  • 1 to 18 years old
  • No prior therapy or limited prior therapy
View Trial

VENAML: Chemotherapy Combined with Venetoclax in Children with Refractory or Relapsed Acute Myeloid Leukemia

A Phase I and Expansion Cohort Study of Venetoclax in Combination with Chemotherapy in Pediatric Patients with Refractory or Relapsed Acute Myeloid Leukemia

Diseases Treated:

Acute myeloid leukemia (AML), acute undifferentiated leukemia, mixed phenotype acute leukemia

Eligibility:

  • Diagnosis of relapsed or refractory acute myeloid leukemia (AML), acute undifferentiated leukemia or mixed phenotype acute leukemia 
  • At least 2 years old and younger than 22 years old
  • Recovered from acute effects of prior therapy and no evidence of graft-versus-host disease (GVHD)
  • Adequate liver, kidney and heart functions
View Trial

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